Management of Glucose-Lowering Therapy in Older Adults with Type 2 Diabetes: Challenges and Opportunities

Jean Doucet,1 Pierre Gourdy,2,3 Laurent Meyer,4 Nabil Benabdelmoumene,5 Isabelle Bourdel-Marchasson6,7 1Department of Polyvalent Internal Medicine, Saint Julien Hospital, Rouen University Hospital, Rouen, France; 2Department of Diabetology, Toulouse University Hospital, Toulouse, France; 3Institute of Metabolic and Cardiovascular Diseases, UMR1297 INSERM/UT3, Toulouse University, Toulouse, France; 4Department of Endocrinology, Diabetes and Nutrition, University Hospital of Strasbourg, Strasbourg, France; 5Department of Internal Medicine and Geriatrics, University Hospital of Marseille, Marseille, France; 6CNRS, CRMSB, UMR 5536, University of Bordeaux, Bordeaux, France; 7University Hospital of Bordeaux, Bordeaux, FranceCorrespondence: Jean Doucet, Email jean.doucet@chu-rouen.frAbstract: The population of older adults (≥ 65 years) with type 2 diabetes mellitus (T2DM) is diverse, encompassing individuals with varying functional capabilities, living arrangements, concomitant medical conditions, and life expectancies. Hence, their categorization into different patient profiles (ie, good health, intermediate health, poor health) may aid in clinical decision-making when establishing glycemic goals and pharmacological treatment strategies. Further granularity in assessing each patient profile through interdisciplinary collaboration may also add precision to therapeutic and monitoring decisions. In this review, we discuss with a multidisciplinary approach how to deliver the best benefit from advanced diabetes therapies and technologies to older adults with T2DM according to each patient profile. There remain however several areas that deserve further research in older adults with T2DM, including the efficacy and safety of continuous glucose monitoring and automated insulin delivery systems, the switch to once-weekly insulin, the effectiveness of multidisciplinary care models, and the use of supported telemedicine and remote blood glucose monitoring in the oldest-old (≥ 85 years) who particularly require the assistance of others.Keywords: type 2 diabetes, older adults, patient profiles, management